Violence and Crises Interventions - PowerPoint PPT Presentation

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Violence and Crises Interventions

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Psychiatric / Mental Health Nursing West Coast University Professional Education and Support Behavioral crisis management programs Increase awareness of risk factors ... – PowerPoint PPT presentation

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Title: Violence and Crises Interventions


1
Violence and Crises Interventions
  • Psychiatric / Mental Health Nursing
  • West Coast University

2
Objectives
  • Describe theoretical perspective in understanding
    violence
  • Identify the presence of behavioral and verbal
    cues that indicate impeding violence
  • Describe nursing measures to de-escalate
    potentially violent behavior within the context
    of the principle of least restrictiveness.
  • Implement a variety of nonpharmacological nursing
    strategies for intervening with violent clients.
  • Identify common staff responses to violence.

3
Objectives
  • Analyze personal feelings and attitudes that may
    affect professional practice when caring for
    clients with aggressive behaviors.
  • Identify problem-solving framework.
  • Identify principles of documentation
  • Review types of restraints
  • Practice evasions from attacks
  • Identify principles of evasion

4
Violence in the Healthcare Setting
  • Definition
  • Verbal or physical threats and/or injury to
    persons or destruction of property
  • 60-90 of nurses experience violence.
  • Psychiatric setting is area of high risk and
    incidence.

5
Basic Premise
  • Students who have reviewed the systematic
    approach to intervention during incidents of
    potential assault are less likely to injure or be
    injured than those who have not.

6
Biopsychosocial Theories
  • Biologic Theories
  • Imbalances of hormones (? testosterone),
    neurotransmitters (?D and NE, ?Achm 5HT, and
    GABA)
  • Genetic abnormalities
  • Neurophysiologic injuries (trauma, anoxia,
    metabolic imbalance, encephalitis, organic brain
    injury)

7
Biopsychosocial Theories - continued
  • Psychosocial Theories
  • Psychoanalytic aggression an innate drive
  • Psychological impairment in impulse control,
    coping, and social skills
  • Sociocultural child abuse, dysfunctional family

8
Biopsychosocial Theories - continued
  • Psychosocial Theories
  • Psychoanalytic aggression an innate drive
  • Psychological impairment in impulse control,
    coping, and social skills
  • Sociocultural child abuse, dysfunctional family

9
Biopsychosocial Theories - continued
  • Behavioral Theory
  • Learned behavior (exposure to violence
  • in media/entertainment)?
  • Humanistic Theory
  • Basic drives unmet

10
Aggression and the Brain
  • Hypothalamus
  • Alarm system, controls pituitary function
  • Dysfunction leads to overreaction to stress and
    overactivation of pituitary
  • Hippocampus
  • Regulates the recall of recent experiences and
    new information
  • Dysfunction associated with impulsivity

11
Aggression and the Brain - continued
  • Amygdala (limbic system)?
  • Frontal cortex

12
Behavioral Cues
  • Clenched jaws and fists
  • Dilated pupils
  • Intense staring
  • Flushing of face and neck
  • Frowning, glaring, or smirking
  • Pacing
  • Increased vigilance
  • Anxiety
  • Destruction of property

13
Verbal Cues
  • Threats of harm
  • Loud demanding tone
  • Abrupt silence
  • Sarcastic remarks
  • Pressured speech
  • Illogical responses
  • Yelling, screaming, cursing
  • Statements of fear or suspicion

14
Exercise
  • Kinds of physically injurious behaviors that you
    may observe in the clinical setting?
  • What needs clients are trying to meet?
  • What alternative behavior will your patients use
    to meet these needs

15
Professionalism
  • Our attitudes influence clients behavior.
    Cynicism, pessimism, and other destructive
    attitudes frequently aggravate assaultive
    incidents. When we accept responsibility for our
    career choice, then we are less likely to
    contribute to unnecessary violence.
  • Attitude
  • Mood
  • Motivation

16
Preparation
  • We should prepare to respond to aggressive
    behavior before they enter the workplace. Then
    they are less likely to injure during an assault.
    The fully prepared student has proper attire,
    adequate mobility, well-practiced observational
    strategies, and an organized plan for
    self-control.
  • Attire
  • Mobility
  • Precautions (Psychiatric and Medical Problems)
  • Observation
  • Self-Control

17
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18
Nursing Process Assessment
  • Risk factors
  • History of violence
  • Severity of psychopathology
  • Higher levels of hostility
  • Length of time in the hospital
  • Early age of onset of psychiatric symptoms
  • Frequency of admission to psychiatric hospitals
  • Agitated delirium / Acute excited state
  • Substance abuse

19
Assessment
  • Assess clients
  • Perception of precipitating event/current
    situation
  • Support system
  • Usual coping patterns
  • Withdrawal symptoms
  • Confusion
  • Pain

20
Assessment - continued
  • Environmental factors
  • Availability of dangerous objects
  • Overcrowding
  • Staffing
  • Supervision
  • Activity level

21
Nursing Diagnoses NANDA
  • Risk for Other-Directed Violence
  • Risk for Self-Directed Violence
  • Anxiety
  • Ineffective Coping
  • Chronic Low Self-Esteem, and Situational Low
    Self-Esteem

22
Other Considerations
  • Impulse control
  • Sensory-perceptual functioning
  • Cognitive functioning
  • Social skills
  • Impaired communication
  • Helplessness
  • Powerlessness
  • Protection of vital interest
  • An aggressive or hostile staff member
  • Changes in role identity
  • Lack of personal space

23
Implementation
  • Develop a therapeutic relationship.
  • Establish trust, maintain safety, and convey
    respect.
  • Use active listening and calm demeanor
  • Address client needs.
  • Use problem solving with the individual
  • Be empathetic
  • Offer assistance and avoid an argumentative
    stance
  • Allow venting and pacing
  • Use open ended questions and give the client time
    to think

24
Interventions
  • Avoid saying you must or you need to
  • Avoid power struggles and judgements
  • Be aware of your nonverbal behavior
  • Be clear and use simple language
  • Decrease environmental stimuli

25
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26
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27
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28
Five Phases of The Assault Cycle
  • Phase 1 The triggering event
  • Phase 2 Escalation
  • Phase 3 Crises
  • Phase 4 Recovery
  • Phase 5 Post-crises depression

29
Nonpharmacologic Strategies - continued
  • De-escalation
  • Assemble a team and brief team members.
  • Clear the area of other clients.
  • Choose a leader.
  • Evasion
  • Appropriate for responding to situation in which
    assault and battery is attempted
  • Prevents injury and avoids the pitfall of
    retaliation or over-reaction
  • Reasonable force

30
Pharmacologic Interventions
  • Pharmacologic agents
  • Antipsychotics (typical and atypical)
  • Benzodiazepines
  • combinations

31
Restrictive Measures
  • Restrictive measures
  • Pharmacologic
  • Seclusion
  • Involuntary confinement
  • Restraint
  • Device attached or adjacent to clients body
    which restricts movement or normal access to
    ones body
  • Documentation required
  • Denial of Rights

32
Safety
  • Minimizing personal risk
  • Nonthreatening communication
  • Awareness of environment
  • Availability of other staff members
  • Awareness of clothing and objects

33
Health Professionals Role
  • Help person in crisis understand what led to the
    crisis and guide him/her toward positive
    resolution
  • Acute phase restore the person to pre-crisis
    level of functioning as quickly as possible

34
Professional Education and Support
  • Behavioral crisis management programs
  • Increase awareness of risk factors, teach staff
    de-escalation strategies and teamwork for
    behavior management/restraint
  • Critical Incident Stress Debriefing (CISD)
  • Staff who experience violent situation discuss
    feelings in safe, supportive environment
  • Reduces long-term negative consequences

35
Nursing Self-Awareness
  • How do I feel about this patient/setting?
  • How are my feelings affecting my behavior?
  • Fear is a normal response.
  • Avoid personalizing.
  • Use intuition.

36
Self-Awareness
37
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38
Practice Evasion From Attacks
  • Evasion from punches, slaps and scratches
  • Evasion from kicks, and knee
  • Cover and deflect when trapped or cornered
  • Evasion from blows with heavy objects
  • Evasion from holding attacks
  • To the skin pinching, digging nails, biting
  • To the hair
  • To the limb
  • To the torso
  • To the neck

39
Principles of Evasion
  • Control yourself
  • Keep talking
  • Be patient
  • Stay out of the way
  • Get out of the way
  • Pat attention
  • Make a plan
  • Track the attack
  • Move in an arc
  • close the attack
  • Escape holding attacks
  • Minimize, release, evade
  • Call for help
  • Avoid inflicting pain and injury
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